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Category: Volume 06 Issue 08 August 2018
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Title: Oral Care in Intubated Patients Weather or not on Mechanical Ventilation: A Systemic Review

Authors: Sanju Kumari, Visanth.VS, Rathish Nai, Krishnaveni.R, Chandrakant Prasad

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i8.64

Abstract

Oral care is an important part of nursing management in intubated patients as it affects both wellness and clinical outcomes of intensive care patients. Many of the intubated patients develop nosocomial pneumonia (ventilator associated pneumonia/VAP when on mechanical ventilation) owing to invasion by oropharyngeal microorganisms in intensive care patients. So İntensive care intubated patients need proper oral assessment and oral care to avoid complications caused by oro-pharyngeal bacteria. In this systemic review we aimed to determine the standard practice guidelines over oral hygiene intubated patients in intensive care unit. For the purpose of collection of data we searched extensively on internet databases including Pub Med, Med know, Google scholar and EBSCO HOST. The keywords used were oral care, oral hygiene practice, mouth care, mouth hygiene, intubated, mechanical ventilation, intensive care and critical care. We analyzed the studies which were performed on adult intensive care intubated patients, published in peer-reviewed indexed journals and preferably done by nursing officers.

Type of studies we analyzed in this systemic review were descriptive evaluation studies, randomised controlled trials, literature review and meta-analysis & randomized clinical trials. After the analysis of all study articles we concluded that oral brushing with chlorhexidine solution in various strength (0.12%, 0.2%, 2%) at least twice a day can reduce the incidence of VAP in intensive care intubated patients.

Keywords: İntensive care, oral care, Ventilator associated pneumonia, intubated patient.

References

  1. Grap MJ, Munro CL. Ashtianni B, Bryant S. Oral care intervention in critical care: frequency and documentation. Am J Crit Care. 2003;12:113-8.
  2. Grap MJ, Munro CL, Elswick RK Jr, Sessler CN, Ward KR, Virginia R. Duration of action of a single, early oral application of chlorhexidine on oral microbial flora in mechanically ventilated patients: a pilot study. Heart & Lung. 2004;33:83-91.
  3. Chalmers J, Pearson A. Oral hygiene care for residents with dementia: a literature review. J AdvNurs. 2005;52:410-9.
  4. Chan EY, Ruest A, Meade M O, Cook DJ. Oral decontamination for prevention of pneumonia in mechanically ventilated adults: systematic review and meta-analysis. Br Med J. 2007;334:889.
  5. Berry AM, Davidson MP, Nicholson L, Pasqualotto C, Rolls K. Consensus based clinical guideline for oral hygiene in the critically ill. Intens Crit Care Nurs. 2011;27:180-8.
  6. Vincent J-L, Rello J, Marshall J, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA 2009;302:2323-2329.
  7. American thoracic society and Infectious Disease society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J RespirCrit Care Med 2005;171:388-416.
  8. Tantipong H, Morkchareonpong C, Jaiyindee S, Thamlikitkul V. Randomized controlled trial and meta-analysis of oral decontamination with 2% chlorhexidine solution for the prevention of ventilator-associated pneumonia. Infect Control Hosp Epidemiol. 2008;29:131-6.
  9. Lin YS, Chang JC, Chang TH, Lou MF. Critical care nurses‟ knowledge, attitudes and practices of oral care for patients with oral endotracheal intubation: a question-naire survey. J ClinNurs. 2011;20:3204-14.
  10. Genuit T, Bochicchio G, Napolitano LM, McCarter RJ, Roghman MC. Prophylactic chlorhexidine oral rinse decreases ventilator-associated pneumonia in surgical ICU patients. Surg Infect (Larchmt). 2001;2:5-18.
  11. Berry AM, Davidson PM, Rolls K. Systematic literature review of oral hygiene practices for intensive care patients receiving mechanical ventilation. Am J Crit Care. 2007;16:552-62.
  12. Bergmans DC, Bonten MJ, Gaillard CA, Paling JC, van der Geest S, van Tiel FH, et al. Prevention of ventilator-associated pneumonia by oral decontamination: a prospective, randomized, double-blind, placebo-controlled study. Am J RespirCrit Care Med. 2001;164:382-8.
  13. Fourrier F, Duvivier B, Boutigny H, Roussel-Delvallez M, Chopin C. Colonization of dental plaque, a source of nosocomial infections in intensive care unit patients. Crit Care Med. 2005;26: 1239-47.
  14. Garcia R, Jendresky L, Colbert L, Bailey A, Zaman M, Majumder M. Reducıng ventılator-assocıated pneumonıa through advanced oral-dental care: a 48-month study. Am J Crıt Care. 2009;18:523-32.
  15. Kollef MH. Prevention of hospital-associated pneumonia and ventilator-associated pneumonia. Crit Care Med. 2004;32:1396-405.
  16. Johnson K, Domb A, Johnson R. One evidence based protocol doesn't fit all: brushing away ventilator associated pneumonia in trauma patients. Intensive Crit Care Nurs. 2012;28:280-7.
  17. Cason CL, Tyner T, Saunders S, Broome L. Nurses‟ ımplementatıon of guıdelınes for ventılator-assocıated pneumonıa from the centers for dısease control and preventıon. Am J Crıt Care. 2007 Jan;16(1):28-36.
  18. DeKeyser Ganz F. ICU nurses‟ oral-care practices and the current best evidence. J NursScholarsh. 2009;41:132-8.
  19. Rello J, Koulenti D, Blot S, Sierra R, Diaz E, De Waele JJ, et al. Oral care practices in intensive care units: a survey of 59 European ICUs. Intensive Care Med. 2007;33:1066-70.
  20. Feider LL, Mitchell P, Bridges E. Oral care practices for orally intubated critically ill adults. Am J Crit Care. 2010;19:175-83.
  21. Houston S, Hougland P, Anderson JJ, LaRocco M, Kennedy V, Gentry LO. Effectiveness of 0.12% chlorhexidine gluconate oral rinse in reducing prevalence of nosocomial pneumonia in patients undergoing heart surgery.Am J Crit Care. 2002;11:567-70.
  22. Munro CL, Grap MJ, Jones DJ, McClish DK, Sesler CN. Chlorhexidine, tooth brushing, and preventing ventilator-associated pneumonia in critically ill adults. Am J Crit Care. 2009;18:428-37.
  23. Yao LY, Chang CG, Maa S, Wang C, Chen CH. Brushing teeth with purified water to reduce ventilator-associated pneumonia. J Nurs Res. 2011;19(4):289-97.
  24. Halm MA, Armola R. Effect of oral care on bacterial colonization and ventilator-associated pneumonia. Am J Crit Care. 2009;18(3):275-8.
  25. Roberts N, Moule P. Chlorhexidine and tooth-brushing as prevention strategies in reducing ventilator-associated pneumonia rates. NursCrit Care. 2011;16:295-302.
  26. Goss LK, Coty MB, Myers JA. A review of documented oral care practices in an intensive care unit. ClinNurs Res. 2011;20:181-96.
  27. Dale C, Angus JE, Sinuff T, Mykhalovskiy E. Mouth care for orally intubated patients: a critical ethnographic review of the nursing literature. Intensive Crit Care Nurs. 2013 Oct;29(5):266-74.
  28. Beraldo CC, Andrade D. Oral hygiene with chlorhexidine in preventing pneumonia associated with mechanical ventilation. J Br Pneumol.2008;34:707-14.
  29. Ross A, Crumpler J. The impact of an evidence-based practice education program on the role of oral care in the prevention of ventilator-associated pneumonia. Intensive Crit Care Nurs. 200;23:132-6.
  30. Fitch JA, Munro CL, Glass CA, Pellegrini JM. Oral care in the adult intensive care unit.Am J Crit Care. 1999;8:314-8.
  31. Berry AM, Davidson PM, Rolls K. Systematic literature review of oral hygiene practices for intensive care patients receiving mechanical ventilation. Am J Crit Care. 2007;16:552-62.
  32. Cuccio L, Cerullo E, Paradis H, Padula C, Rivet C, Steeves S, et al. An evidence-based oral care protocol to decrease ventilator-associated pneumonia. Dimens Crit Care Nurs. 2012;31:301-8.
  33. Bopp M, Darby M, Loftin KC, Broscious S. Effects of daily oral care with 0.12% chlorhexidine gluconate and a standard oral care protocol on the development of nosocomial pneumonia in intubated patients: a pilot study. J Dent Hyg. 2006;80:9.
  34. Labeau SO, Van de Vyver K, Brusselaers N, Vogelaers D, Blot SI. Prevention of ventilator-associated pneumonia with oral antiseptics: a systematic review and meta-analysis. Lancet Infect Dis. 2011;11:845-54.
  35. Anaissie EJ, Penzak SR, Dignani MC. The hospital water supply as a source of nosocomial infections: a plea for action. Arch Intern Med. 2002;162:1483-92.
  36. Maria Perno Goldie Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia (review). 2013

Corresponding Author

Mrs. Sanjukumari

Nursing Officer, College of Nursing, All India Institute of Medical Sciences, Phulwarisharif, Patna- 801507 Bihar, India

Ph:- 8521941428, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.